Appropriate use of AED?

[SoCal student]

I've been an RN for 7 years in acute psych inpatient and administered CPR for the first time just this week. I never even had a chance to administer CPR as a student and have been lucky enough to have not needed it in 7 years of practice. It was also my first time ever using anything other than a practice AED.

Pt. fell suddenly, possibly hitting her head on a desk (no trauma noted) and was unresponsive. APN present could not locate a pulse and CPR was initiated.

The AED was expectedly as dummy-proof as the practice ones - I opened it up, threw the pads on and let it do its thing. AED advised a shock and the patient was shocked once. CPR was resumed and pt. was responsive within about 30 seconds. We detached the AED.

EMS arrived, took over, and transferred pt. to hospital. But, one of paramedics apparently questioned "Why did you guys shock her?" in a condescending tone. I wasn't present at this point but other nurses felt that he was implying we did something wrong. It's my understanding that they shock manually based on the rhythm they see. But I also assume he knows that we use automatic defib that does all that work for us.

This seems pretty straight-forward, right? Putting an AED on an unresponsive pt. with no pulse and allowing it to shock when advised?

The AED only shocks if it deems necessary, which means she was in an appropriate arrhythmia?

I've yet to return to work and assume we'll debrief with admin on this as it's something that is extremely rare at our facility so I've just been sitting around kind of anxious about it.

[Wuzzie]

There’s a tiny chance he was just trying to get a history of the events and everyone’s emotions were a bit riled up making people uber sensitive but honestly he probably was being condescending. There always seems to be one in the bunch. There’s a name for it...”para-gods”. They reflect poorly on the rest of us and are an embarrassment to the uniform. AED’s are automatic. You didn’t shock the patient, the machine determined it was needed and proceeded. Everything you did was correct. In all likelihood the patient fell because of a lethal cardiac rhythm. Your actions restored NSR and the patient recovered. You guys just saved a life! Ignore the people who want to take that away from you.

FTR, I’m not bashing medics (I am one) because you’ll find people like this everywhere. We’re having a real problem with our RRT members treating their peers like idiots in front of patients and family members. Asking “why” someone did something can be very dicey as it can be interpreted in so many ways...most of them negative.

[Lunah, MSN, RN]

31 minutes ago, Wuzzie said:

but honestly he probably was being condescending. There always seems to be one in the bunch. There’s a name for it...”para-gods”. They reflect poorly on the rest of us and are an embarrassment to the uniform.

Yep, I had the same thought. All hail the glitter patch! ?

OP, you all did a GREAT job!!

[CharleeFoxtrot, BSN, RN]

^ what Wuzzie and Pixie said.

[MunoRN, RN]

You nailed it, no reason to feel bad, nice save.

It could be that the medic was just being an ***, but it's also possible that they were asking what rhythm the patient initially in since they are going to be asked that by the receiving ER, possibly assuming you had a defib that shows the rhythm, without realizing you were using an AED which doesn't show a rhythm.

If the patient is pulseless and the AED says to shock then you let it shock, you did it right.

[SoCal student]

Awesome, thanks for the insight, ya'll.

[JKL33]

7 hours ago, Wuzzie said:

In all likelihood the patient fell because of a lethal cardiac rhythm. Your actions restored NSR and the patient recovered. You guys just saved a life!

Yep.

OP you did guys did awesome!

I will say that sometimes people focus on one thing when hearing a story...you know...maybe they misunderstood it to be a primary head trauma situation, rather than being completely incidental to someone going down with a lethal arrhythmia. Oh well. Whatever their issue was, it doesn't change the fact that you totally saved somebody. Nice work.

[CKPM2RN, ASN, EMT-P]

If it ever happens again your answer is, "Because the AED indicated a shock was needed." In your most snotty reply tone you can muster. An AED won't shock anything but a shockable rhythm. PS. You did great!!

[CharleeFoxtrot, BSN, RN]

27 minutes ago, CKPM2RN said:

If it ever happens again your answer is, "Because the AED indicated a shock was needed." In your most snotty reply tone you can muster. An AED won't shock anything but a shockable rhythm. PS. You did great!!

I'd do it something like

Quote

I dunno, I heard this little voice whisper "shock advised" and just pushed the button.

while twirling a hank of hair around my finger and rolling my eyes. But that's just me ?

[Wuzzie]

Not gonna lie I KNOW I’d respond with “what part of automatic do you not understand” while holding up the machine and pointing at where it said AED.

[PeakRN]

I wouldn't put any emotional investment in it, it isn't worth it. Any competent paramedic understands how an AED works, so he was either incompetent or being rude.

If you are interested in the rhythm you can have the AED interrogated by the manufacturer and they can see the rhythm it recorded when it advised a shock.

[amoLucia]

There always seems to be some type of a 'superior attitude turf war' among different groups of healthcare providers. Even among different groups of nurses - ICU nurses sniff at the floor nurses, hospital staff sniff at LTC, day shift does all the busy stuff while nites has it real easy, etc. Hey, even you psych nurses just sit around and talk to pts. You get what I"m saying?!

Who knows what his motive was. But it was HIS; not all professionals are like that.

You did good!